US Medicare, Medicaid chief urges states to implement health law

July 13, 2012|Reuters

By Anna Yukhananov

WASHINGTON, July 13 (Reuters) - The head of the U.S.government's Medicare and Medicaid health programs urgedRepublican state governors to implement President Barack Obama'shealthcare law to extend coverage to millions of uninsuredAmericans, many of them poor or handicapped.

Opposition to Obama's signature domestic policy achievementhas become a rallying cry among Republicans, with at least fivegovernors saying they would not implement the law's expansion ofthe Medicaid program for the poor and handicapped.

With the U.S. Supreme Court having upheld the law asconstitutional earlier this month, Republicans are now focusedon winning control of the White House and enough seats inCongress in the Nov. 6 elections to repeal it.

Marilyn Tavenner, the acting head of the Centers forMedicare and Medicaid Services (CMS), wrote that states have nodeadline for when they have to comply with the Medicaidexpansion mandated under the new law, but they should not waste"a good deal," according to a letter obtained by Reuters.

Medicare is the healthcare program for the elderly.

"We hope that states will not turn down the resources andflexibility offered in the Affordable Care Act (Obama healthcarelaw), and will put aside old political battles to move forwardwith implementation," she wrote in a letter addressed toVirginia Governor Bob McDonnell, who is also head of theRepublican Governors Association.

In its ruling upholding the healthcare overhaul, the SupremeCourt allowed states to opt out of the expansion of Medicaid,which is jointly funded by federal and state governments andrepresents the biggest spending item in most state budgets.

The expansion would raise the limit on annual income foreligible families, and aims to extend health coverage to 16million Americans.

Some state officials are worried about a rise in Medicaidcosts in the wake of the ruling, even with the government'scommitment to fund the entire Medicaid expansion in the firstthree years and 90 percent of it thereafter.

In a letter to Obama earlier this week, McDonnell alsoexpressed concern about the uncertainty surrounding thesubsidized health insurance exchanges which must be set up aspart of the law to extend health coverage.

States that decline to submit plans for their own exchangeby Nov. 16 would require the federal government to step in andoperate them, but McDonnell said it was unclear if thegovernment will be ready or have the funds to fully implementthe law when it takes full effect in 2014.

"We believe it is incumbent upon the authors of (the law)and your administration to detail precisely how you intend toaddress this situation," he said in the letter to Obama, whichwas sent on behalf of Republican governors.

So far, 13 states have committed to establishing astate-based health exchange, according to the U.S. Department ofHealth and Human Services. At the same time, 17 states have madeno significant progress towards establishing an exchange orrejected the idea, according to the Kaiser Family Foundation,which tracks healthcare issues.

Some health experts fear many states holding off onexchanges will wait for the outcome of the November elections.Since building the technological infrastructure requires time,states that wait could be ill-prepared by the autumn of 2013when the federal government wants the exchanges to acceptenrollment.

CMS's Tavenner said the government was open to working withthe states, and said they could apply for federal funding toimplement exchanges or expand Medicaid. She said they would nothave to pay the money back if they ultimately decided not toparticipate.

"We expect that, as states study their options, they willrecognize that this (law) is a good deal," she said.